What's at Stake if ACA is Overturned?

As the Supreme Court holds hearings on the
constitutionality of the Affordable Care Act (ACA), up to 31 million people stand to lose healthcare coverage.

March 28, 2012

(The author is a Reuters columnist. The opinions expressed are
his own.)

CHICAGO, March 28 - Ordinary Americans have a lot
at stake this week as the Supreme Court holds hearings on the
constitutionality of the Affordable Care Act (ACA).

It is not clear what the outcome will be, and it is not
clear where Americans stand on it. While two-thirds of
Americans oppose the individual insurance mandate that is at the
heart of the Obama Administration's healthcare reform law,
according to a Kaiser Family Foundation survey, the polls also
reveal more nuanced attitudes.

Americans are evenly divided on the overall law, with 47
percent supporting it, according to Pew Research. And a New York
Times/CBS News poll finds that many of the law's key provisions
are backed by large majorities: the law's popular features
include the requirement that insurance companies cover people
with pre-existing conditions (85 percent), letting children stay
on parents' policies until age 26 (68 percent) and cutting the
cost of prescription drugs for seniors (77 percent).

Here's a breakdown of what is at stake if the Supreme Court
strikes down the law:

BENEFITS ALREADY IN PLACE: Although key benefits of the ACA
won't be implemented until 2014, significant changes are already
in place. For example, 2.5 million young adults age 19 to 25 are
now covered on their parents' policies. For Medicare, the first
steps to close the gap in prescription drug coverage -- the
notorious "donut hole" -- saved $2.1 billion for nearly 3.6
million seniors last year, according to the U.S. Department of
Health and Human Services.

STATE EXCHANGES: State insurance exchanges, which are being
set up now and will fully launch in 2014, will open up access to
insurance for anyone who can't access group healthcare coverage
through the workplace -- a crucial, growing problem in an
economy characterized by volatility and stubbornly high levels
of structural unemployment.

For example, nine million Americans age 50 to 64 were
uninsured as of 2010 -- up from 5.3 million in 2002, according
to The Commonwealth Fund. Too young for Medicare, their only
option now is the individual insurance market, where premium
prices are high, coverage is partial and many can't buy policies
at all due to pre-existing conditions. Nine million individuals
were turned down for coverage in the individual market over the
past three years due to pre-existing conditions, Commonwealth
says.

Starting in 2014, the law will ban charging higher premiums
or denying coverage based on health or age, and insurance
companies will no longer be permitted to disqualify applicants
based on pre-existing conditions. And applicants will be
eligible for federal subsidies on the cost of coverage if they
make less than 400 percent of the federally defined poverty
level -- currently $92,000 for a family of four. For this group,
the subsidy uses a sliding scale to hold costs as a share of
income between 2 percent and 9.5 percent.

The Congressional Budget Office (CBO) projects that 23
million Americans will gain coverage through the state exchanges
by 2019. "That's a very sweeping change for people who need to
retire early, are unemployed, or have a job that doesn't offer
health care benefits," says Sara Collins, vice president for
affordable insurance at The Commonwealth Fund.

The process will start with an application for insurance
submitted to your state exchange; depending on your income,
you'll be eligible to buy a policy in the exchange -- or receive
coverage under Medicaid.

MEDICAID EXPANSION: Medicaid primarily serves parents with
very low incomes, and few states cover adults who do not have
children. The ACA provides federal funding for a dramatic
expansion of Medicaid. The new program will serve all households
that are living around the federal poverty level -- about
$30,000 in annual income for a family of four. Fifty-seven
percent of adults in that income range were uninsured for at
least part of 2011, and 41 percent were uninsured for one year
or longer.

So that's what's at stake if the healthcare reform law is
struck down by the Supreme Court. All told, 31 million Americans
who otherwise would have health insurance won't be covered at
the end of this decade, and we'll be back to the drawing board
on healthcare reform. Here's hoping it doesn't happen.
(Editing by Beth Pinsker Gladstone and Andrea Evans)